AB0635 HAEMATOLOGICAL MANIFESTATIONS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: REAL WORLD DATA FROM A CENTRE IN NORTHERN ITALY
Authors: R. Borrelli, N. Rashidy, F. Meli, E. Saracco, F. Corradi, I. Badiu, S. Nicola, L. Lo Sardo, L. Brussino
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder characterized by a variety of signs and symptoms; it manly affects women of childbearing age, with an estimated prevalence of 24/100,000 people in Europe and North America. Among other clinical manifestations, haematological involvement is one of the most common in SLE as it includes anaemia, leukopenia, lymphopenia, thrombocytopenia, lymphadenopathy and splenomegaly; furthermore, it is usually challenging to discriminate whether such manifestations are caused by disease or by immunosuppressants. To date, few studies tried to evaluate them using real world data. <h3>Objectives</h3> To evaluate haematological manifestations in patients with SLE by using real world data. <h3>Methods</h3> A retrospective study was performed by gathering real world data. 2019 EULAR/ACR Classification Criteria for SLE were used to discern haematological involvements in patients with a diagnosis of SLE; leukopenia, thrombocytopenia and autoimmune haemolytic anaemia (AIHA) were considered for this study. Six subgroups were formed as each condition alone and their combinations were analyzed. Logistic regression was used to calculate the odds ratio (OR) and a 95% confidence interval (CI) was chosen to assess statistical significance. <h3>Results</h3> One hundred and forty-two patients affected by SLE were enrolled in this study (N=142); among these, thirty met the inclusion criteria for haematological manifestations (n=30, 52 ±12.4 years, 28 F, 2 M). Three patients showed AIHA alone (10.0%), six had thrombocytopenia only (20.0%) and 8 displayed leukopenia alone (26.7%). Thirteen patients showed a combination as 6 people had both AIHA and thrombocytopenia (20.0%) and 4 manifested AIHA in association with leukopenia (13.3%); lastly, 3 patients showed thrombocytopenia with leukopenia (10.0%). The latter proved to be the most common manifestation as leukopenia was present in 15 out of 30 patients (50.0%) (Figure 4). Azathioprine (AZA), in association with hydroxychloroquine (HCQ), was used in 8 patients (26.6%), while a combination of Mycophenolate Mofetil (MMF) and HCQ was found in 5 out of 30 patients (16.7%); seventeen patients received either HCQ alone or a biologic drug (Belimumab). Among patients in therapy with AZA or MMF, the former proved to be more frequently associated with leukopenia vs MMF (OR<sub>1</sub>=2.5); however, the result was not statistically significant (CI<sub>1</sub>95% 0.77; 8;04); a similar result was observed for both patients in therapy with MMF or AZA when compared to HCQ alone or HCQ + Belimumab (OR<sub>2</sub>=1.16, OR<sub>3</sub>=0.46, respectively) since they did not reach statistical significance. <h3>Conclusion</h3> In this preliminary study, real-world data proved essential to analyze patients affected by SLE. Among many haematological manifestations, leukopenia showed to be the most frequent in agreement with data published in literature, strictly followed by thrombocytopenia and AIHA. AZA was linked with a higher percentage of leukopenia compared to MMF or other therapies but the result was not statistically significant. This study has some limitations (number of enrolled patients, possible selection bias) which require further evaluations to be properly assessed. <h3>References</h3> [1]Mariëlle et al, <i>Incidence of invasive pneumococcal disease in immunocompromised patients,</i> Travel Medicine and Infectious Disease, 2018 [2]Levine AB et al, Clinical assessment and management of cytopenias in lupus patients. Curr Rheum Rep. 2011 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.